Letters: There is no support or justification for the health bill

Health minister Simon Burns (Letters, 31 January) denied that the health and social care bill privatises health services and emphasised its intention to reduce bureaucracy and shift power to patients and professionals. We disagree with this assessment of the implications of the bill. Indeed the clinical commissioning groups have no direct accountability to local patients or the citizens in their locality; a far cry from the “big society” or indeed the spirit of the 2007 Local Government and Public Involvement in Health Act.

Instead the bill emphasises and promotes the commercialisation of health service provision and the privatisation of provision and service commissioning. While health financing is not yet privatised, the bill’s intent is to promote diversification of provision. This change will make the NHS more vulnerable to both European and international commercial law that regulates internal markets, government procurement and trade in services. This will shift power to EU-level and multinational service provider organisations and consultancies and away from local communities.

The public rates the NHS highly, and patient satisfaction ratings continue to be buoyant. A more fragmented and commercialised health service will be less able to control costs, ensure continuity of care or equality of access, or retain a common identity.Dr Meri Koivusalo Senior researcher in international health policy, Professor Jonathan Tritter Warwick Business School

• Simon Burns is correct to say that the government is not privatising the NHS – but only in a very narrow sense: the government will continue to fund the health service. However, it is planning to delegate the management and effective control of the NHS to private companies who will be paid to compete with each other. The finances of these companies will not be open to public scrutiny because their contracts will be protected by commercial confidentiality clauses.

Mr Burns says that GPs will play a key role. Oxfordshire has 83 GP practices comprising hundreds of individual doctors. When I asked representatives of the current (soon to be abolished) primary care trust how in practice all these doctors would be able to make so many important decisions, they said that nobody knew: the new system has not been trialled. The government has embarked on a massive, destructive and expensive reorganisation without knowing how it will work, and without producing a shred of evidence that it will result in a better, fairer and cheaper service. But we can be reassured that this is not privatisation: we will all continue to pay for it, whatever the outcome. Bernard DodBanbury, Oxfordshire

• The Department of Health justifies persisting with the health and social care bill in the face of overwhelming evidence of the damage it will cause because “Our reforms are based on what NHS staff themselves have consistently said” (Report, 31 January). Yet the latest YouGov poll of NHS staff found that 72% expect the new system to be more costly, 83% think it will increase bureaucracy, 66% think that the reforms will make the NHS worse and 65% (80% after excluding don’t knows) believe the bill should be withdrawn entirely. Am I misunderstanding something?Professor Martin McKeeLondon School of Hygiene and Tropical Medicine